Methods and apparatus for facilitated, hierarchical medical diagnosis and symptom coding and definition

ABSTRACT

Patient pre-screening is facilitated through a system of hierarchically linked catalogues, each comprising at least one condition-descriptive entry. The hierarchy of linked catalogues is essentially tree structure in which the content of the lower-level catalogues is dependent upon particular entries in upper-level catalogues. In one embodiment, the uppermost catalogue comprises a model display of a male or female. In general, a condition-descriptive entry from an uppermost catalogue is selected. The selected condition-descriptive entry from the uppermost catalogue determines at least one lower-level catalogue that is subsequently displayed By traversing the linked catalogues in this manner, a concise diagnosis or symptom description may be quickly and accurately generated. In one embodiment of the present invention, diagnoses arrived at through the hierarchical structure include an ICS-9 code, thereby facilitating implementations of databases.

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] Related subject matter is found in U.S. Pat. No. 5,441,047, and U.S. Pat. No. 5,544,649, the teachings of which patents are hereby incorporated by this reference. This is a patent application based upon previously filed U.S. provisional application Serial No. 60/205,186 filed May 18, 2000, for Method and Apparatus for Facilitating Medical Pre-Screening for which priority is claimed.

TECHNICAL FIELD

[0002] The present invention relates to techniques for medical diagnosis, symptom coding and definition.

BACKGROUND OF THE INVENTION

[0003] Before the advent of electronic data processing, clinical medical records were generally either handwritten or transcribed. This offered almost no ability to search for and analyze clinical information. Further exacerbating this situation, patient complaints often differ widely even when describing the same condition, thus making such complaints most difficult to capture in a structured manner.

[0004] To achieve at least a basic level of commonality, structure and accessibility, codes to be used when performing patient diagnosis, such as the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM, hereinafter “ICD-9”), were established. However, codebooks are long and cumbersome to use, thus making codification a very time-consuming and error-prone task. A system is needed to simplify and expedite their application. Moreover, in the process of monitoring patients and/or interviewing patients for subsequent physician examinations, a method for obtaining more consistent and standardized patient information (i.e., problem definitions and complaint formalizations) is required. Such a technique will be crucial in creating a database that can be used for future statistical analysis and decision support.

[0005] U.S. Pat. Nos. 5,441,047 and 5,544,649 (“the '047 and '649 patents”), incorporated by reference, disclose an interactive, two-way audio-visual communication system for use in monitoring ambulatory (at home) patients. In particular, the '047 and '649 patents describe a system wherein a health care worker at a central station monitors and/or examines the patient, while the patient is at a remote location. The patient may be a person having a specific medical condition being monitored or may be an elderly person desiring general medical surveillance in the home environment. Cameras are provided at the patient's remote location and at the central station such that the patient and the health care worker are in interactive visual and audio communication. A communications network such as an interactive cable television is used for this purpose. Various medical condition sensing and monitoring equipment are placed in the patient's home, depending on the particular medical needs of the patient. The patient's medical condition is measured or sensed in the home and the resulting data is transmitted to the central station for analysis and display. The health care worker then is placed into interactive visual communication with the patient concerning the patient's general well being, as well as the patient's medical condition. Thus, the health care worker can make “home visits” electronically, twenty-four hours a day.

[0006] A technique combining the monitoring techniques of the '047 and '649 patents with an improved method of patient medical diagnosis, consistent, standardized record keeping and symptom coding would be an advancement of the art.

SUMMARY OF THE INVENTION

[0007] The present invention provides a technique for facilitating the acquisition of standardized patient medical information through a system of hierarchically linked catalogues, each comprising at least one condition-descriptive entry. The hierarchy of linked catalogues is essentially a tree structure in which the content of the lower-level catalogues is dependent upon particular entries in upper-level catalogues. In one embodiment, the uppermost catalogue comprises a model display of a male or female. In general, a user of the system selects a condition-descriptive entry from an uppermost catalogue. The selected condition-descriptive entry from the uppermost catalogue determines at least one lower-level catalogue that is subsequently displayed to the user. By traversing the linked catalogues in this manner, the user of the system can arrive at a concise diagnosis or symptom description. Because the condition-descriptive entries in each catalogue are predetermined, commonality of problem descriptions is inherent. In one embodiment of the present invention, diagnoses arrived at through the hierarchical structure include an ICD-9 code, thereby facilitating implementations of databases. These and other advantages and features of the subject invention will become apparent from the detailed description of the invention that follows.

BRIEF DESCRIPTION OF THE DRAWINGS

[0008] In the detailed description of presently preferred embodiments of the present invention which follows, reference will be made to the drawings comprised of the following figures, wherein like reference numerals refer to like elements in the various views and wherein:

[0009]FIG. 1 is a more detailed functional block diagram of the data analysis and display center of the central station of FIG. 2;

[0010]FIG. 2 an illustration of one possible arrangement of the health monitoring and telecommunications equipment in the central stations;

[0011]FIG. 3 an illustration of one possible arrangement of the medical condition measuring, sensing and telecommunications equipment in a patient's home environment;

[0012]FIG. 4 illustrates an exemplary hierarchy in accordance with the present invention;

[0013]FIG. 5 illustrates an exemplary first embodiment of a plurality of hierarchically linked catalogues each comprising at least one condition-descriptive entry in accordance with the present invention;

[0014]FIGS. 6A and 6B illustrate an exemplary second embodiment of a plurality of hierarchically linked catalogues each comprising at least one condition-descriptive entry in accordance with the present invention; and

[0015]FIG. 7 illustrates an exemplary problems/complaints list in accordance with the present invention.

DETAILED DESCRIPTION OF THE INVENTION

[0016] The system of the present invention may use or incorporate inexpensive home medical monitoring equipment that includes a camera, sensors and measuring devices for the particular medical parameters to be monitored. The patient's home equipment is simple to use and modular to allow for the accommodation of the monitoring device to the specific needs of each patient. To reduce production costs and to avoid complex maintenance problems, the home unit includes only the sensor part of the measuring device. The raw data, including video image data, is transmitted to the central station, which includes all of the needed sophistication to allow for the storage, transformation, display and interpretation of the data. The need for expensive equipment in the home is thus avoided. Inexpensive sensors are placed in the patients' homes, and the more costly analytic equipment for all the patients is located at the central station.

[0017] The central station includes a computer-based multi-channel data analysis and display unit that enables the interpretation, display, and storage of the transmitted data. This central station is preferably equipped with alarm mechanisms to alert the staff to any aberration from the expected. The central station further includes apparatus for the communication of data to all authorities involved in the wide spectrum of the patient's needs, e.g., emergency care agencies, the patient's physician, nursing services, social workers, etc.

[0018] The central station is preferably provided with the capability of automatically scanning predesignated patient home units at predetermined intervals to provide continuous supervision of specific parameters. In some instances, the central station may monitor continuously one or more parameters, e.g., ECG, blood pressure, respiration, etc., for hours or even days, thereby creating a semi-intensive-care capability. The embodiment disclosed enables one highly trained nurse or patient monitoring personnel located at the control center to supervise and monitor a multitude of patients either seriatim or substantially simultaneously. Whereas a visiting nurse may only be able to visit 5 or 6 homes per day in person, a nurse at the central station may be able to visit 5 or 6 patients per hour by making electronic “home visits”.

[0019] Cable television provides an already existing, widespread and ideal system for interactive visual communication with most residential units in densely populated urban areas. The ambulatory patient monitoring system integrating the latest advances in biomedical technology with cable television provide safe and accurate general and medical supervision for the geriatric/homebound population in their own, natural environment.

[0020] Using such an interactive system, a direct visual uni- or bi-directional contact between the elderly person monitored and the supervision is established at any time, day or night. This contact can be initiated, at will, by the patient monitor or by the patient. Moreover, this communication system is used to transfer general data as well as medical data from sensors to monitor the various medical and non-medical parameters. Further, a health practitioner may be able to have “classes” with many remotely located patients.

[0021] Cable television networks provide a useful mode of communication between the patient's remote location and the central station at the present, and is a presently preferred means for transmission of the audio-visual signal from the patient to the central station and for transmission of the audio-visual signal of a health practitioner to the patient's remote location. Further, the measured medical data can be displayed in the patient's remote location and the parameters picked up by the camera. The transmission of the measured medical data may also be by cable television, or may be through another communication network such as the telephone system. The data transmission could also be by microwave, cable, or other transmission means. It will be appreciated that as advances in telecommunications develop, other techniques for transmission of video signals between a central station and the home may be desirable and economically feasible. For example, satellite and radio transmission of the video signal and/or monitored medical data, or transmission via modem through the telephone lines, may also prove satisfactory.

[0022] Communication between the patient's remote location and the central station can be initiated by a variety of techniques. One method is by manually or automatically placing a call on the telephone to the patient's home or to the central station. When the call is received, a responsive switch is thrown, turning on the camera in the patient's home or at the central station. Alternatively, the patient and central station could agree on times or time intervals in which communication would take place. Ideally, a remote control button on the patient's chair is installed which, when activated, turns on the equipment in the home and alerts the health practitioner at the central station.

[0023] Referring now to FIG. 1. Data indicating the medical condition of the patient is sensed in the patients' remote location and may be sent via the telephone lines to the central station 20. The data is in turn relayed on a data bus 68 into a central computer 70. The central computer 70 has both a data storage center 72 (including volatile and/or non-volatile memory, as known in the art), and a central processing unit (CPU) 74. The data storage center 72 stores incoming patient data for a given period of time, which may be over 24 hours, so that a physician or health practitioner can go back through the patient's medical data, during the previous 24 hours for example, and ascertain what the patient's health or condition was at a certain period of time. This capability is important for diagnostic purposes because it allows the physician to monitor and analyze the patient's medical condition prior to a given event such as a cardiac arrest. The physician can simply enter commands into the keyboard 76 to access particular data from a particular period of time and display the information. For example, the physician may have the patient monitored for electrical activity in the heart. The patient will have a set of electrodes attached to his chest and the electrical potentials are measured on the surface of the chest. The data analysis and display unit 28 may further include a means for transferring the medical data onto high storage capacity media 77 such as optical disks, which can then be retrieved at a later point in time. The diagnostic tools provided by this data analysis and display center significantly enhances the ability to monitor patients in the home and to diagnose precise medical conditions based on the collected data. Because the present invention provides a technique amenable to the use of standardized codes in diagnosing patients and describing their symptoms, the stored data may be readily searched and analyzed in a coherent manner.

[0024] Still referring to FIG. 1, the audio-visual signal from the patient is fed on cable 84 to a video storage unit 86. Again, a health care practitioner or physician may enter commands at the keyboard 76 for the central computer 70 and retrieve the audio-visual signal stored in the video storage unit 86 such that he or she can see the picture of the patient on a TV screen 88 either simultaneous with its transmission from the patients' remote location 10, or during a previous period of time. For example, if the patient was experiencing chest pains at 3:00 a.m. the previous day, the physician may want to see the picture of the patient at 3:00 a.m. The physician enters a command into the keyboard 76, or manipulates the video data storage device 86, such as a VCR, to retrieve the video picture of the patient 16 at 3:00 am. The picture of the patient 16 is displayed on the screen 88 together with a time field 90. The physician can then have the display units 82 or 78 display the electrocardiograms in a one or two-dimensional image to correspond with the patient's picture at that period of time so he can match up the medical data with the video image of the patient.

[0025] Also depicted in FIG. 1 is a computer monitor 150 of the type well known in the art. The computer monitor 150 is used, in one embodiment of the present invention, as part of a user interface along with a user interface selection device (such as a mouse, touch screen, voice recognition interface, etc.) to allow the health care practitioner to operate software programs stored in memory 72 and executed by the processor 74. In particular, the healthcare practitioner can use the two-way, audio visual communication capabilities of the present invention to perform medical pre-screening on diagnostic record keeping using software programs running on the computer 70. As described herein.

[0026] Referring now to FIG. 2, there is illustrated one possible arrangement of the health monitoring and telecommunications equipment at the central station 20 surrounding the health practitioner or nurse 112. The nurse 112 enters via keyboard 76 of the central computer 70 commands to call up on the TV screen 88 the patient 16 of interest. The commands may also include commands to start up the camera in the patients home. The central computer 70 is linked with the switching center 34 (FIG. 2) such that any of the subscriber patients can be accessed. Preferably, the patient's medical records and history are entered into the computer 22 such that when the particular patient is selected, the history is displayed either on the display 150 of computer 70 or on a separate screen 152. This enables the nurse 112 to rapidly familiarize herself with the patient. If the patient's data is being simultaneously transmitted to the central station 20, the patient's ECG or cardiac activity can be displayed on displays 78 and 82, respectively. Alternatively, the patient's oximetry data may be displayed for a given period of time on a separate display 154. The nurse 112 also has a camera 22 oriented towards her which generates an audio-visual signal for transmission to the patient's remote location 10.

[0027] The patient depicted in FIG. 3 may be examined for various ambulatory and other physical characteristics useful in the diagnosis of patient health, for example the predisposition to fall. For example, gait and mobility of the patient may be examined and analyzed using the system of the invention. Specifically, the video camera 22 may include a lens having a wide angle vision field. The patient 16 can be orally instructed by the health practitioner to position himself at a start position in the vision field, for example, standing erect at the center of the vision field at a specified distance from the camera 22. The practitioner 112 will direct the patient 12, having been positioned at the start position, to conduct specific physical activities such as specific arm movements, walking, bending, etc.

[0028] The video image data generated in this manner is transmitted to the central station where it can be recorded for subsequent analysis. As described in greater detail below, the video image data can then be used to generate motion characteristics data for comparison with previously stored standard data or previously recorded data for that patient. Also the recorded visual signal may be reviewed by the practitioner for purposes of diagnosis and advice to the patient. Thus, the predisposition of a patient to fall and the potential reasons for a fall can be predicted and preventive intervention can be attempted. For example, a change in medication can be prescribed or physical therapy may be instituted. The system may then be utilized to monitor the results of the prescribed medication or therapy.

[0029] Thus, the video image data alone may be relied upon to provide a medical signal or diagnostic information relating to specific body parts or functions, just as physicians and medical practitioners regularly rely upon visual diagnosis. The system of the invention permits such diagnosis. As another, rather than using a wide angle video input to view the entire patient in an ambulatory condition to study gait, etc., a narrow field or angle signal can be utilized to conduct, for example, an eye examination. Such an examination could focus on eye movement, pupil size under differing conditions, eye reaction time, eye condition in view of a regimen of medication, and numerous other diagnostic matters. The condition and color of skin can also be examined using a narrow field visual technique. Again, the visual condition of a patient is an important diagnostic tool and reaction to medication, growth of moles, and skin disturbances can be recorded, compared to standards and prior data in an ongoing manner to facilitate patient treatment.

[0030] Building upon the interactive audio-visual communication system described above, the present invention facilitates patient diagnosis and record keeping through the use of hierarchically linked catalogues comprising condition-descriptive entries. FIG. 4 illustrates an exemplary hierarchy 700 in accordance with the present invention. In particular, the hierarchy 700 comprises a well-known tree structure. As shown, a topmost element “A” is linked to lower level elements, here labeled “B” and “C”. Elements “B” and “C”, in turn, are linked to still-lower elements “D”, “E”, “F” and “G”, respectively. Even lower elements “H”, “I”, “J”, “K” and “L” are linked to higher level elements “D” and “F”, respectively. An arbitrary number of levels may be provided. If successively lower levels of elements are considered as increasing specific descriptions of medical diagnoses and/or symptoms, it becomes readily evident that the tree structure may be traversed from top to bottom to efficiently arrive at such diagnoses or symptom descriptions. The present invention builds upon this principle, as described in greater detail below.

[0031] Referring now to FIG. 5, an exemplary first embodiment of a plurality of hierarchically linked catalogues 802-806 (each comprising at least one condition-descriptive entry) is illustrated. In particular, the example illustrated in FIG. 5 allows a health care practitioner to arrive at a diagnosis through increasingly specific condition-descriptive entries. Generally, the plurality of hierarchically linked catalogues is generated using software routines executed by a suitable computing platform and displayed on a monitor or similar device. For example, with reference to FIG. 2, the catalogues are displayed on the monitor 150 based on software executed by the computer 80.

[0032] In the example illustrated in FIG. 5, three catalogues 802-806 are illustrated. A topmost or uppermost catalogue 802 is logically positioned at the top of the hierarchy. In accordance with the present invention, the uppermost catalogue 802 generally comprises the most general condition-descriptive entries. Successively lower catalogues 804-806 comprise correspondingly more specific condition-descriptive entries. In particular, the catalogues 802-806 are organized according to a System-Subsystem-Diagnosis hierarchy, as described below. Although only three catalogues are illustrated in FIG. 5, it is understood that a greater or lesser number of catalogues could be used and arranged in this manner.

[0033] Each condition-descriptive entry within a given catalogue preferably comprises a medically acceptable term or group of terms useful in aiding a health care practitioner to describe a patient's symptoms and/or categorize a portion of the patient's body. Within a given catalogue, each condition-descriptive entry preferably describes the symptoms/body portion at a given level of abstraction, with successively lower categories corresponding to successively lower levels of abstraction, i.e., increasingly specific entries. A feature of the present invention is the hierarchical linking of the catalogues such that selection of an entry in a given catalogue automatically determines which lower level catalogues are displayed. By asking the patient to describe his or her condition at each catalogue level, a health care practitioner may select a condition-descriptive entry and continually narrow the diagnosis/symptom description until a final level of abstraction or description is achieved.

[0034] For example, the uppermost catalogue 802 in FIG. 5 comprises “Systems” entries descriptive of general body systems, e.g., digestive, respiratory, etc. By selecting an uppermost condition-descriptive entry 808, in this case “Digestive”, a lower level catalogue 804, listing various “Organs” logically grouped together underneath the “Digestive” system, is automatically displayed. Likewise, selection of another condition-descriptive entry 812, in this case “Stomach/Duodenum”, causes a further lower level catalogue 806, listing various diagnoses applicable to the “Stomach/Duodenum”, to be automatically displayed. Because the lowest level catalogue comprises the most specific condition-descriptive entries, selection of a final condition descriptive entry 816 is equivalent to a final diagnosis; in this case, a diagnosis calling for “Diagnostic procedures on stomach (including gastroscopy).” Throughout this selection process, selection windows 810, 814, 818 display the selected condition-descriptive entries 808, 812, 816 thereby allowing the health care practitioner to quickly confirm entries as they are selected. Note that although specific condition-descriptive entries (i.e., ICD-9 codes) are shown in FIG. 5, it is understood that the present invention is not limited in this regard. Indeed, a large number of condition-descriptive entries may be included in each catalogue thereby requiring the use of scroll-bars or similar mechanisms.

[0035] In one embodiment of the present invention, specific codes 822 are included with the diagnosis entries in the diagnosis catalogue 806, which codes are uniquely descriptive of the selected diagnosis. In a preferred embodiment, the codes 822 comprise ICD-9 codes. The use of specific codes provides uniformity across diagnoses and further facilitates database implementations, including efficient searching and data analysis. To further facilitate the process, definitions (diagnoses) in the diagnosis catalog 806 are dynamically sorted according to frequency of use. In such doing, most frequent definitions (diagnoses) are always shown on the first panel and are therefore easily accessible.

[0036] An “Add to problems list” button 820 is also illustrated in FIG. 5. The problems button 820 allows the health care practitioner, once he or she is satisfied with the completeness and accuracy of the diagnosis, to have data representative of the selected diagnosis 816 (and, optionally, the higher-level condition-descriptive entries 808, 812) stored in a database or other long term memory. Techniques for capturing data in this manner are well-known in the art. By maintaining a list of such data, a complete history of each patient's problems/diagnoses may be provided, as described in greater detail below with reference to FIG. 7.

[0037] Referring now to FIGS. 6A and 6B, an exemplary second embodiment of a plurality of hierarchically linked catalogues 902, 908, 914-922 (each comprising at least one condition-descriptive entry) is illustrated. In particular, the example illustrated in FIGS. 6A and 6B allows a health care practitioner to arrive at a symptom description through increasingly specific condition-descriptive entries. Generally, the plurality of hierarchically linked catalogues is generated using software routines executed by a suitable computing platform and displayed on a monitor or similar device. For example, again with reference to FIG. 5, the catalogues are displayed on the monitor 150 based on software executed by the computer 80. As before, the specific number of catalogues shown in FIGS. 6A and 6B are for illustrative purposes only; any number of catalogues may be provided as a matter of design choice.

[0038] In contrast to the strictly text based catalogues illustrated in FIG. 5, FIG. 6A illustrates catalogues 902, 908 based on model displays 904, 910. In particular, a male model display 904 and a zoom display 910 are shown. Of course, female model displays may be chosen depending on the gender of the patient under consideration. When using the model displays 904, 910, the condition-descriptive entries correspond to predetermined regions of the model display. Thus, a health care practitioner, through a user interface selection device such as a mouse-cursor combination, for example, can select a given region on the model display corresponding to a problem region described by a patient. (This mode of data entry is particularly useful where interactive audio-visual communication with the patient is possible, for example, when using the system described above relative to FIGS. 1-3.) In the example shown in FIG. 6A, a head region 906 has been selected. Any number of specific regions may be defined as a matter of design choice, which regions can be overlapping or non-overlapping. Preferably, the model display may be rotated around at least one axis (preferably, at least a vertical axis) to provide a complete display of all possible regions. Techniques for providing and manipulating such displays are well known in the art.

[0039] Once a region 906 has been selected, the zoom display 910 may be optionally provided. The zoom display 910 corresponds to a lower level catalogue relative to the male model display 904, with the various sub-regions depicted therein corresponding to lower-level condition-descriptive entries. For example, within the head region 906, the zoom display 910 allows selection of a sinuses sub-region 912. Because the contents of the zoom display 910 are dictated by the particular region 906 selected in the larger model display 904, the hierarchical catalogue structure provided through the use of text-only catalogues is maintained.

[0040] More conventional text-based catalogues 914-916 may be provided as an alternative to, or in addition to, the model displays 904, 910. Where provided, such catalogues operate in the manner described above relative to FIG. 5. That is, various condition-descriptive entries 924, 928 may be selected, thereby allowing the user to traverse the hierarchical catalogue structure. Regardless, selection of a given region and, optionally, sub-region automatically causes a further catalogue 918, in this case a “Symptoms” catalogue, to be displayed. The “Symptoms” catalogue 918 list one or more condition-descriptive entries appropriate to the selected region/sub-region combination. In the example illustrated in FIG. 6B, only a single “Pain” entry 932 is displayed. Selection of this entry automatically causes additional lower-level catalogues 920, 922 to be displayed based on the particular entry 932 selected. Where only a single entry 932 is provided in a higher level catalogue, one or more lower level catalogues dependent on the single entry may be provided before the single entry is selected. In the example illustrated in FIG. 6B, a “General Qualifiers” catalogue 920 and a “Special Qualifiers” catalogue 922 are provided relative to the selected entry 932. Particular condition-descriptive entries 936, 940 may be selected from the respective qualifiers catalogues 920, 922. The resulting symptom description is therefore the collection of condition-descriptive entries selected from the various lower level catalogues, in this case “acute sinus pain resulting from an injury.” As in the example of FIG. 5, the text-based catalogues 914-922 provide selection windows 926, 930, 934, 938 942 such that a user of the catalogues may verify the selections as they are made. Once again, scroll bars may be used with any of the text-based catalogues 914-922 in those instances where the number of condition-descriptive entries is relatively large. Although particular condition-descriptive entries are illustrated in FIGS. 6A and 6B, it is understood that the present invention is not limited in this regard.

[0041] Finally, a “Save Complaints” button 944 is also illustrated in FIG. 6B. The complaints button 944 allows the health care practitioner, once he or she is satisfied with the completeness and accuracy of the symptom description, to have data representative of the described symptom stored in a database or other long term memory. Techniques for capturing data in this manner are well-known in the art. By maintaining a list of such data, a complete history of each patient's problems/diagnoses may be provided, as described in greater detail below with reference to FIG. 7.

[0042] Referring now to FIG. 7, an exemplary problems/complaints list in accordance with the present invention is illustrated. Generally, the list comprises problems/diagnoses and/or complaints/symptoms generated when a health care practitioner traverses the hierarchically linked catalogues, as described above, and saves the results to a database. The accumulated results can then be displayed as shown in FIG. 7. Techniques for storing and later processing such data for display are well known in the art. In particular, the list comprises a current problems/diagnoses section 1002 and a current complaints/symptoms section 1014. The data shown in the problems/diagnoses section 1002 results from traversal of, for example, catalogues of the type described above relative to FIG. 5. Similarly, the data shown in the complaints/symptoms section 1014 results from the traversal of, for example, catalogues of the type described above relative to FIGS. 6A and 6B.

[0043] A shown, the problems/diagnoses section 1002 comprises a problems/diagnosis name field 1004, an onset data field 1006, a severity field 1008, a change severity button 1010 and an old problems display button 1012. The problems/diagnoses name filed 1004 is where textual data descriptive of each particular problem/diagnosis is displayed. In a preferred embodiment, the textual data for each problem/diagnosis is a predetermined character string selected in accordance with the ICD-9 coding system. Although not shown, the corresponding ICD-9 code may also be displayed. The onset date field 1006 sets forth the date the particular problem began according to the patient. The dates illustrated in FIG. 7 are shown in a day/month/year format. The date data may be entered directly into the onset date field for each problem. The severity field 1008 sets forth the severity of the particular problem. In a preferred embodiment, severity of a problem is limited to Chronic, Active and Not Active, as shown. Of course, other severity descriptors may be used as a matter of design choice. The severity change button 1010 allows the severity for a given problem to be changed as necessary. In one embodiment, the severity change button 1010 is in the form of a pull down menu, although other embodiments will be readily evident to those having ordinary skill in the art. Alternatively, the severity data may be directly entered directly into to the severity field for each problem. Finally, the old problems display button 1012 allows one or more previously entered, but no longer current, problems to be displayed along with the most recently entered problem. Note that where a relatively large number of problems/diagnoses need to be displayed, scroll bars or similar mechanisms may be employed.

[0044] The complaints/symptoms section 1014 is similarly structured and comprises an onset date field 1016, a complaint/symptom description field 1018, a move to old complaints button 1020 and a show old complaints button 1022. The onset date filed 1016, like its counterpart in the complaints/diagnoses section 1002, sets forth the date, according to the patient, a given symptom first manifested itself. Using an alternative representation, the dates illustrated in the date fields 1016 are shown in a month/day/year format. As before, the date data for a given complaint/symptom may be entered directly into the onset date fields 1016. The complaint/symptom description field 1018 comprises the descriptions resulting from the traversal of the hierarchically linked catalogues, as described above. The descriptions are preferably standardized descriptions according to an accepted standard such as ICD-9, for example. As complaints/symptoms are alleviated or otherwise go away, they may be archived using the move to old complaints button 1020. That is, once it is determined that a given complaint/symptom is no longer relevant, it may be selected and, by activating the move to old complaints button 1020, it is no longer displayed with the current complaints/symptoms, but the data is archived in long term memory. When activated, the show old complaints button 1022 causes the archived complaint/symptom data to be recalled and displayed.

[0045] The present invention facilitates medical prescreening and coding by providing for the quick, efficient and reliable capture of patient diagnoses and/or symptom descriptions as well as other coding systems and definitions such as procedures, diagnostic tests, medical billing codes (HCFA, Medicare etc.) and more. The use of a hierarchy of previously defined catalogues limits reduces and places structure upon the data capture steps. It minimizes the time required to enter information into the system by drastically reducing search time, standardizing the input of data and eliminating the need for writing or typing in the problem description. By incorporating the use of ICD-9 codes, a user has no need to worry about looking up or entering the required code. This does away with an important source of conflict among concerned parties: the adequate codification of problems that for billing purposes has to comply with the mentioned code. The use of standardized terms to capture patient data makes possible the implementation of database queries for statistical analysis and decision support. Data from years of patient observation acquires renewed significance and relevance, as it becomes available for use by a larger segment of the population. Furthermore, by enabling the physician or medical worker to use a human body model to link regions of the body to the patients' complaint, and by the use of a hierarchy of catalogues, the present invention allows medical workers to pinpoint a patient's complaint more precisely. Further still, the catalogues may be customized to meet the particular requirements of a given practitioner or practice. Finally, because the hierarchy of catalogues is quickly and easily traversed, the patient is easily and reliably prescreened by a medical worker who does not necessarily need to entire skill set of a physician, thereby allowing physicians to be concentrate their efforts on those patients who are most in need of them.

[0046] While the foregoing detailed description sets forth preferably preferred embodiments of the invention, it will be understood that many variations may be made to the embodiments disclosed herein without departing from the true spirit and scope of the invention. For example, three other embodiments possible in the recognition of body parts for complaint formalization: (1) the patient points to a body part relevant to his/her complaint and the medical worker at the central station recognizes the region by clicking on it in the patients' image on the screen in front of him; (2) the patient points to the part of his body that is relevant to his complaint and image recognition software automatically recognizes the region; and (3) verbally, the patient recognizes the body part relevant to his complaint and the relevant region is recognized automatically using speech recognition methods. Other such modifications within the scope of the present invention may be readily devised by those having ordinary skill in the art. Nevertheless, the scope of the present invention is defined by the appended claims, to be interpreted in light of the foregoing specifications. 

What is claimed is:
 1. A method for facilitating medical pre-screening, the method comprising steps of: providing an uppermost catalogue of a plurality of hierarchically linked catalogues, wherein each of the plurality of hierarchically linked catalogues comprises at least one medical condition-descriptive entry; receiving an indication of a selected uppermost condition-descriptive entry from the uppermost catalogue; and providing at least one additional lower catalogue of the plurality of hierarchically linked catalogues based on the selected uppermost condition-descriptive entry.
 2. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 1. 3. The method of claim 1, wherein each catalogue of plurality of hierarchically linked catalogues comprises a menu.
 4. The method of claim 1, wherein the uppermost catalogue comprises a body systems catalogue and the at least one condition-descriptive entry included therein corresponds to at least one body system entry.
 5. The method of claim 4, wherein the selected uppermost condition-descriptive entry corresponds to a selected body system entry, and wherein the at least one additional lower catalogue comprises a subsystems catalogue and the at least one condition-descriptive entry included therein corresponds to at least one subsystem entry based on the selected body system entry.
 6. The method of claim 5, further comprising a step of: receiving an indication of a selected subsystem entry from the subsystems catalogue, wherein the step of providing the at least one additional lower catalogue further comprises providing a diagnosis catalogue based on the selected subsystem entry, and wherein the at least one condition-descriptive entry included in the diagnosis catalogue corresponds to at least one diagnosis entry based on the selected subsystem entry.
 7. The method of claim 6, wherein each of the at least one diagnosis entry comprises an ICD9 code.
 8. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 7. 9. The method of claim 1, wherein the uppermost catalogue comprises a model display of either a male model or a female model.
 10. The method of claim 1, wherein the uppermost catalogue comprises a body parts catalogue and the at least one condition-descriptive entry included therein corresponds to at least one body part entry.
 11. The method of claim 10, wherein the selected uppermost condition-descriptive entry corresponds to a selected body part entry, and wherein the at least one additional lower catalogue comprises a symptoms catalogue and the at least one condition-descriptive entry included therein corresponds to at least one symptom entry based on the selected body part entry.
 12. The method of claim 11, further comprising a step of: receiving an indication of a selected symptom entry from the symptoms catalogue, wherein the step of providing the at least one additional lower catalogue further comprises providing a general qualifier catalogue based on the selected symptom entry, and wherein the at least one condition-descriptive entry included in the general qualifier catalogue corresponds to at least one general qualifier entry based on the selected symptom entry.
 13. The method of claim 12, wherein the step of providing the at least one additional lower catalogue further comprises providing a special qualifier catalogue based on the selected symptom entry, and wherein the at least one condition-descriptive entry included in the special qualifier catalogue corresponds to at least one special qualifier entry based on the selected symptom entry.
 14. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 13. 15. In a computer system comprising a display and a user interface selection device, a method for facilitating medical record generation, the method comprising steps of: providing, on the display, a plurality of hierarchically linked catalogues, wherein each of the plurality of hierarchically linked catalogues comprises at least one medical condition-descriptive entry; receiving, via the user interface selection device, selection information corresponding to user selections from a portion of the plurality of hierarchically linked catalogues, wherein the at least one condition-descriptive entry included in each lower-level catalogue of the portion of the plurality of hierarchically linked catalogues is based on the user selections relative to at least one higher-level catalogue of the portion of the plurality of hierarchically linked catalogues; and providing, on the display, a diagnosis based on the user selections.
 16. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 15. 17. The method of claim 15, wherein each catalogue of plurality of hierarchically linked catalogues comprises a menu.
 18. The method of claim 15, wherein the diagnosis comprises an ICD9 code.
 19. The method of claim 15, further comprising steps of: providing, on the display, a problem input mechanism; receiving, via the user interface selection device, an indication of user selection of the problem input mechanism; and providing, on the display and responsive to the indication of user selection of the problem input mechanism, a patient problem list comprising the diagnosis.
 20. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 19. 21. The method of claim 19, wherein the patient problem list comprises a severity field, the method further comprising steps of: receiving severity level information relative to the diagnosis; and providing, on the display, the patient problem list comprising the severity level information for the diagnosis.
 22. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 21. 23. The method of claim 19, wherein the patient problem list comprises an onset date field, the method further comprising steps of: receiving onset data information relative to the diagnosis; and providing, on the display, the patient problem list comprising the onset date information for the diagnosis.
 24. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 23. 25. In a computer system comprising a display and a user interface selection device, a method for facilitating medical record generation, the method comprising steps of: providing, on the display, a plurality of hierarchically linked catalogues, wherein each of the plurality of hierarchically linked catalogues comprises at least one medical condition-descriptive entry; receiving, via the user interface selection device, selection information corresponding to user selections from a portion of the plurality of hierarchically linked catalogues, wherein the at least one condition-descriptive entry included in each lower-level catalogue of the portion of the plurality of hierarchically linked catalogues is based on the user selections relative to at least one higher-level catalogue of the portion of the plurality of hierarchically linked catalogues; and providing, on the display, a qualified symptom description based on the user selections.
 26. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 25. 27. The method of claim 25, wherein at least one catalogue of the plurality of hierarchically linked catalogues comprises a model display of either a male model or a female model.
 28. The method of claim 27, further comprising a step of: receiving, via the user interface selection device, an indication of a selected portion of the model display.
 29. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 28. 30. The method of claim 28, further comprising a step of: providing, on the display, an enlarged display of the selected portion.
 31. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 30. 32. The method of claim 25, further comprising steps of: providing, on the display, a symptom input mechanism; receiving, via the user interface selection device, an indication of user selection of the symptom input mechanism; and providing, on the display and responsive to the indication of user selection of the symptom input mechanism, a patient complaint list comprising the qualified symptom description.
 33. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 32. 34. The method of claim 32, wherein the patient problem list comprises a severity field, the method further comprising steps of: receiving severity level information relative to the qualified symptom description; and providing, on the display, the patient complaint list comprising the severity level information for the qualified symptom description.
 35. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 34. 36. The method of claim 32, wherein the patient problem list comprises an onset date field, the method further comprising steps of: receiving onset data information relative to the qualified symptom description; and providing, on the display, the patient complaint list comprising the onset date information for the qualified symptom description.
 37. A computer-readable medium comprising computer-executable instructions for performing the steps recited in claim
 36. 38. The method of claim 1, 15 or 25 in combination with a method for remote monitoring of a subject including the steps of acquiring the medical condition entry from a remote monitoring site and transmitting information from a subject located at the information to a central record keeping site. 